Provider Demographics
NPI:1124354345
Name:NORTHERN WISCONSIN BONE & JOINT
Entity type:Organization
Organization Name:NORTHERN WISCONSIN BONE & JOINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLEJNICZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-358-1911
Mailing Address - Street 1:7520 HWY 51 S
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-8943
Mailing Address - Country:US
Mailing Address - Phone:715-358-1911
Mailing Address - Fax:715-358-1912
Practice Address - Street 1:5200 HUMMINGBIRD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-6312
Practice Address - Country:US
Practice Address - Phone:715-358-1911
Practice Address - Fax:715-358-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21298800Medicaid
WICQ2410OtherRR MEDICARE
WI1052540001OtherDMERC
WICQ2410OtherRR MEDICARE
WI21298800Medicaid
WI000044000Medicare PIN